A. Information & Statistics About Diabetes
The Centers for Disease Control and Prevention (CDC) provides basic information about diabetes, as well as statistics about the disease.
People who live in rural areas have higher rates of diabetes than those who live in urban areas, but have more limited diabetes self-management and education support (DSMES) services.
B. Statutory Authority for Diabetes Self-Management Training (DSMT)
Section 4105(a) of the Balanced Budget Act (BBA) of 1997 (pub. L. 105-33), enacted on August 5, 1997, provides for Medicare coverage for DSMT services provided by a “certified provider.” Section 4105 of the BBA amended section 1861 of the Social Security Act (The Act) by adding a new section (q)(q).
Additionally, section 4105(c)(1) of the BBA requires the Secretary to establish outcome measurements for purposes of evaluating the improvement of the health status of Medicare beneficiaries with diabetes.
Section 1861(qq) of the Act provides the Centers for Medicare & Medicaid Services (CMS) with the statutory authority to regulate Medicare outpatient coverage of DSMT services.
- The term “diabetes outpatient self-management training services” is defined at 1861(q)(q)(1) of the Act as “educational and training services furnished …to an individual with diabetes by a certified provider… in an outpatient setting by an individual or entity who meets the quality standards…, but only if the physician who is managing the individual's diabetic condition certifies that such services are needed under a comprehensive plan of care related to the individual's diabetic condition to ensure therapy compliance or to provide the individual with necessary skills and knowledge (including skills related to the self-administration of injectable drugs) to participate in the management of the individual's condition.
- The term “certified provider” is defined at section 1861(q)(q)(2)(A) of the Act as “a physician, or other individual or entity designated by the Secretary, that, in addition to providing diabetes outpatient self-management training services, provides other items or services for which payment may be made under this title.”
Section 1861(q)(q)(2) provides that the Department of Health and Human Services Secretary may recognize a physician, individual, or entity that is recognized by an organization as meeting standards for furnishing these services as a certified DSMT provider. This statute also provides that a physician or other individual or entity shall be deemed to have met such standards if they meet applicable standards originally established by the National Diabetes Advisory Board.
Section 1861(q)(q)(2)(B) of the Act states that “a physician, or such other individual or entity, meets the quality standards… if the physician, or individual or entity, meets quality standards established by the Secretary, except that the physician or other individual or entity shall be deemed to have met such standards if the physician or other individual or entity meets applicable standards originally established by the National Diabetes Advisory Board and subsequently revised by organizations who participated in the establishment of standards by such Board, or is recognized by an organization that represents individuals (including individuals under this title) with diabetes as meeting standards for furnishing the services.”
A final rule (65 FR 83130) was published in the Federal Register on December 29, 2000, which implemented the BBA provisions addressing the coverage, payment, quality standards, and accreditation requirements for DSMT. This final rule also implemented the DSMT regulations which are codified at Title 42 of the Code of Federal Regulation (CFR) sections 410.140 to 410.146.
The CMS regulations at 42 CFR 410.144 provide the authority for the CMS to require the DSMT AOs to use one of the following types of accreditation standards: (1) the accreditation standards set forth at §410.144(a); (2) the accreditation standards issued by the National Standards for Diabetes Self-Management Education Support (NSDSMES) (§410.144(b)); or (3) other accreditation standards, so long as they have been submitted to CMS and approved as meeting or exceeding the CMS quality standards described at §410.144(a).
42 CFR § 410.145 of the CMS DSMT regulations specifies the requirements that DSMT entities (suppliers) must meet.
42 CFR § 410.146 requires that approved DSMT entities (suppliers) collect and record in an organized systematic manner, patient assessment information at least on a quarterly basis for a beneficiary who receives DSMT training.
II. Information about the Diabetes Self-Management Training Accrediting Organizations (AOs)
A. General Information
Application for CMS-designation as a CMS-approved DSMT AO is voluntary.
Application and re-application procedures are set forth in the CMS regulations at 42 CFR 410.142.
42 CFR, §410.143(a) sets forth the ongoing responsibilities of the DSMT AOs. The requirement at §410.143(b) sets forth the oversight activities that CMS, or its agent, will perform to ensure that a CMS approved DSMT AO and the entities the organization accredits continue to meet a set of quality standards described at §410.144.
The American Diabetes Association® (ADA) and the Association of Diabetes Care & Education Specialists (ADCES) are the two national DSMT AOs approved by CMS to accredit entities that furnish DSMT services.
These DSMT AOs are approved by CMS for six-year terms.
The ADA and ADCES use the accreditation standards established by the NSDSMES. These standards have been approved by CMS as meeting or exceeding the standards set forth at 42 CFR 410.144.
The NSDSMES quality standards are reviewed and revised approximately every five years by a task force of key stakeholders and experts within the diabetes care and education community. The current version of the NSDSMES standards was released in February 2022. These standards are scheduled for review again in 2027.
B. Information About the ADA Education Recognition Program (ERP)
All entities that provide DSMES that are operating under the current NSDSMES are eligible to apply for ADA recognition of the DSMES program.
Services planning on applying for recognition will need to submit an ERP onboarding form to be set up in the application portal. Application supporting documents (which are outlined in the online application) must be either uploaded into the application portal or emailed to the ADA ERP department as an attachment. Find all application resources including examples, templates, and Ask the ERP Experts.
The application is reviewed by an ERP team member and the applicant is notified via the application portal of the application approval for a four-year recognition period. The applicant will also be notified via the portal if the application has deficiencies and will be provided guidance of documentation reflecting specific recognition elements required for the application approval.
ADA recognized DSMES programs and their locations can be searched via zip code. The ADA performs a random audit of less than 5% of all recognized programs, a maximum of 70 required audits each year.
The entity is notified 12 working days prior to the audit and there are no unannounced visits.
The entity is provided with the Audit Preparation Toolkit to guide the DSMES quality coordinator in audit preparation and documentation required reflecting adherence to the DSMES standards.
C. Information About ADCES
ADCES is the only organization dedicated solely to the specialty of diabetes care and education. ADCES has the expertise and resources required to support DSMES programs throughout our organization and specifically within our Diabetes Education Accreditation Program (DEAP) Department. ADCES, through collaboration with other diabetes organizations, jointly revises and embraces the NSDSMES. The NSDSMES is the framework upon which accreditation is based. ADCES’ interpretive guidance is collaboratively developed with stakeholders and quality coordinators, abides by these standards and is approved by CMS.
ADCES DSMES program accreditation is intended for DSMES services provided in the non-acute care setting.
ADCES offers 1 type of DSMT Accreditation, with these features:
- Program flexibility.
- Accreditation for traditional and nontraditional programs.
- Find a variety of site types to meet your local needs: Community, Branch, State and Microsite.
- Simple fee structure.
- User-friendly web-based application.
- Any entity that provides DSMES services, regardless of eligibility to receive reimbursement, is eligible to apply.
- ADCES facilitates a random on-site audit of approximately 5% of all programs each year with a minimum of 44 audits per year and a maximum of 70 audits per year.
- Programs are randomly selected for virtual audits. If a program is selected for a virtual audit, the quality coordinator will be notified prior to the audit date by email.
- Volunteer auditor findings are reviewed in collaboration with DEAP team and program is notified within two weeks of the virtual audit if correction plan is required and a reasonable timeline is agreed upon.
III. Contact Information for CMS-designated DSMT AOs
The contact information for the DSMT AOs is listed below.
American Diabetes Association (ADA)
2451 Crystal City Drive
Arlington, VA 22202
Association of Diabetes Care & Education Specialists (ADCES)
125 S Wacker Drive
Chicago, IL 60606
IV. Oversight & Validation Process for DSMT AOs' Accreditation Processes
- CMS must provide external oversight of the DSMT AOs to ensure that federal requirements are met by the DSMT entities that are accredited by those AOs.
- The DSMT oversight and validation process, implemented in 2005, was developed by CMS to evaluate the performance of CMS approved DSMT AOs.
- The oversight and validation of the DSMT AOs accreditation process assists CMS in its efforts to determine whether approved DSMT AOs are functioning in the manner required under Medicare regulations.
- CMS uses a contractor to perform the oversight and validation process and report their findings to CMS.
- The oversight and validation process consists of implementing a survey tool and use of a scoring mechanism.
V. Where to Submit Questions Related to the DSMT Accreditation Program
Questions about the DSMT Accreditation Program may be submitted to the DSMT Accreditation email box. We monitor this email box on a frequent basis and will respond to your email as soon as possible.